Key result
Mechanical support alone for cardiogenic shock after acute myocardial infarction has an 80% mortality rate, similar to medical therapy, while emergency revascularization can reduce mortality to 40%.
Why the study?
What are the survival outcomes associated with different circulatory support and revascularization strategies in patients with cardiogenic shock due to acute myocardial infarction?
What are the survival outcomes associated with different circulatory support and revascularization strategies in patients with cardiogenic shock due to acute myocardial infarction?
Emergency revascularization (angioplasty/CABG) and mechanical bridging to transplantation significantly improve survival in cardiogenic shock complicating acute MI compared to medical therapy or mechanical support alone.
Cardiogenic shock after acute myocardial infarction develops according to the amount of lost myocardium, function of remote myocardium, and the phenomenon of infarct expansion. Patients treated with mechanical support alone, without additional measures, have a mortality rate of 80%, the same as patients treated medically. Emergency angioplasty and emergency coronary artery bypass grafting can reduce mortality in certain subsets of patients to 40%. Patients with more severe shock and secondary organ dysfunction may be treated with mechanical bridging to transplantation with survival rates varying between 45% and 76%. Percutaneous support systems may be used to resuscitate a patient or to temporize, allowing time to perform diagnostic studies to determine if the patient is suitable for revascularization or heart transplantation. Intravenous enoximone may improve cardiac function as well and thus allow better decision making for further therapy.
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Moritz et al. (1993) conducted a review in Cardiogenic shock after acute myocardial infarction. Mechanical support and revascularization vs. Medical therapy was evaluated on Mortality. Mechanical support alone for cardiogenic shock after acute myocardial infarction has an 80% mortality rate, similar to medical therapy, while emergency revascularization can reduce mortality to 40%.
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